TCRN UPDATED ACTUAL Questions and CORRECT Answers
1. Most common Falls
mechanism of in-
jury
2. Forms of energy -mechanical
-gravitational
-thermal
-chemical
3. Types of trauma -blunt
-penetrating
-burn
-other
4. Blunt trauma accounts most injuries sustained
frontal impact
-aortic & cardiac injury, rib fxs, liver & spleen
-dash board posterior hip fx/dislocation, femur, knee injury
lateral impact
-head/facial, c spine, clavicle, pelvic, liver/spleen
rear end
-low velocity, neck hyperextension/hyperflexn
rollover
-DAI
ejection
-risk of death 4x greater
pedestrian vs car
-tib/fib fx, truncal, head injury
bicycle
-head and abdominal injury from handlebar
falls
, -4 stories 50% will die
-calcaneous, pelvis, spine, arm fx
5. Penetrating Trau- lower incidence higher mortality
ma GSW
Stab: low velocity higher direct damage to organs
Burn: thermal or inhalation
Other: Hanging, strangulation , suttocation, drowning
6. Waddell's Triad -femoral shaft fx
-intrathoracic and abdominal injury
-contralateral head injury
7. Newton's three 1. object at rest will stay at rest, object in motion will stay in motion
laws of motion 2. Force: F=ma applying force produces acceleration (think seatbelt sign)
3. Action & Rxn: Every action there is an equal and opposite reaction
8. ABCDE "do your Airway obstruction is major cause of preventable trauma deaths
job" Primary Sur- Hemorrhage is the most common cause of mortality in trauma
vey Airway-get definitive airway
Circulation-IV access and IVF
Disability-assess LOC GCS scale
Exposure-get your pt naked! temperature control
-hypothermia=acidosis, coagulopathy, low O2
Hemorrhage Control-STOP THE BLEED replace volume loss, use tourniquet-note
tourniquet time
-<6yo IO access preferred over central line
MTP
-1:1:1 pRBC:plasma:platelet
-pt receiving >10 units pRBC w/in 24 hrs admit
9. Edema, hemorrhage, fracture to obstruct airway and an ET/NT cannot be placed
-closed head injury w/ GCS <8
, When is a defini- -unresponsive
tive airway need- -neuromuscular paralysis
ed? -apnea
-sustained seizure activity
-inability to protect lower airway from blood/secretion
10. Breathing As- -rate
sessment -depth
-ettort
-symmetry
-watch for tension pneumothorax!!
11. Open pneumoth- 3 sided dressing
orax dressing
12. Confirm airway -cords visualized
placement -chest rise and fall
-auscultate
-CO2 detector
-pulse ox
-CXR
13. Adult IVF bolus 1-2 liters if no contraindication
14. Pediatric IVF bo- 20ml/kg
lus
15. Secondary Sur- a head-to-toe physical assessment; an additional assessment of a patient to
vey determine the existence of any injuries other than those found in the primary
survey, history or scene detail
16. Cardiac Output HR (beats/min) x SV (cc/beat)
(L/min)
, 17. Shock Definition State in which perfusion is compromised @ cellular level d/t:
-insuflcient oxygen delivery
-increased oxygen consumption
-inettective oxygen utilization
18. Hypovolemic most common type shock: significant loss circulating volume most common
Shock source acute blood loss (hemorrhage)
-AMS first sign of shock
-Tachycardia >120 very concerning-one of 1st signs
-Cool clammy skin d/t vasoconstriction
-prolonged CRT
-Narrowed pulse pressure (40-50mm)
-Hypotension
-Decreased UO
-adult 0.5mL/kg/hr
-child 1mL/kghr
-toddler 1.5 mL/kg/hr
-Infant 2mL/kg/hr
19. Hemorrhagic Goal: STOP THE BLEED & definitive control of hemorrhage and restoration of
Shock Goals adequate circulating volume
20. Hemorrhagic Look @ chest, abdomen, pelvis
Shock
21. Class I Hemor- up to 15% blood loss, minimal tachycardia, no measurable changes in BP, HR, RR
rhage ex. someone who donated blood
22. Class II Hemor- 15-30%, uncomplicated hemorrhage, 1-2 L of crystalloid
rhage increased HR, narrowed pulse pressure
23. Class III Hemor-
rhage
1. Most common Falls
mechanism of in-
jury
2. Forms of energy -mechanical
-gravitational
-thermal
-chemical
3. Types of trauma -blunt
-penetrating
-burn
-other
4. Blunt trauma accounts most injuries sustained
frontal impact
-aortic & cardiac injury, rib fxs, liver & spleen
-dash board posterior hip fx/dislocation, femur, knee injury
lateral impact
-head/facial, c spine, clavicle, pelvic, liver/spleen
rear end
-low velocity, neck hyperextension/hyperflexn
rollover
-DAI
ejection
-risk of death 4x greater
pedestrian vs car
-tib/fib fx, truncal, head injury
bicycle
-head and abdominal injury from handlebar
falls
, -4 stories 50% will die
-calcaneous, pelvis, spine, arm fx
5. Penetrating Trau- lower incidence higher mortality
ma GSW
Stab: low velocity higher direct damage to organs
Burn: thermal or inhalation
Other: Hanging, strangulation , suttocation, drowning
6. Waddell's Triad -femoral shaft fx
-intrathoracic and abdominal injury
-contralateral head injury
7. Newton's three 1. object at rest will stay at rest, object in motion will stay in motion
laws of motion 2. Force: F=ma applying force produces acceleration (think seatbelt sign)
3. Action & Rxn: Every action there is an equal and opposite reaction
8. ABCDE "do your Airway obstruction is major cause of preventable trauma deaths
job" Primary Sur- Hemorrhage is the most common cause of mortality in trauma
vey Airway-get definitive airway
Circulation-IV access and IVF
Disability-assess LOC GCS scale
Exposure-get your pt naked! temperature control
-hypothermia=acidosis, coagulopathy, low O2
Hemorrhage Control-STOP THE BLEED replace volume loss, use tourniquet-note
tourniquet time
-<6yo IO access preferred over central line
MTP
-1:1:1 pRBC:plasma:platelet
-pt receiving >10 units pRBC w/in 24 hrs admit
9. Edema, hemorrhage, fracture to obstruct airway and an ET/NT cannot be placed
-closed head injury w/ GCS <8
, When is a defini- -unresponsive
tive airway need- -neuromuscular paralysis
ed? -apnea
-sustained seizure activity
-inability to protect lower airway from blood/secretion
10. Breathing As- -rate
sessment -depth
-ettort
-symmetry
-watch for tension pneumothorax!!
11. Open pneumoth- 3 sided dressing
orax dressing
12. Confirm airway -cords visualized
placement -chest rise and fall
-auscultate
-CO2 detector
-pulse ox
-CXR
13. Adult IVF bolus 1-2 liters if no contraindication
14. Pediatric IVF bo- 20ml/kg
lus
15. Secondary Sur- a head-to-toe physical assessment; an additional assessment of a patient to
vey determine the existence of any injuries other than those found in the primary
survey, history or scene detail
16. Cardiac Output HR (beats/min) x SV (cc/beat)
(L/min)
, 17. Shock Definition State in which perfusion is compromised @ cellular level d/t:
-insuflcient oxygen delivery
-increased oxygen consumption
-inettective oxygen utilization
18. Hypovolemic most common type shock: significant loss circulating volume most common
Shock source acute blood loss (hemorrhage)
-AMS first sign of shock
-Tachycardia >120 very concerning-one of 1st signs
-Cool clammy skin d/t vasoconstriction
-prolonged CRT
-Narrowed pulse pressure (40-50mm)
-Hypotension
-Decreased UO
-adult 0.5mL/kg/hr
-child 1mL/kghr
-toddler 1.5 mL/kg/hr
-Infant 2mL/kg/hr
19. Hemorrhagic Goal: STOP THE BLEED & definitive control of hemorrhage and restoration of
Shock Goals adequate circulating volume
20. Hemorrhagic Look @ chest, abdomen, pelvis
Shock
21. Class I Hemor- up to 15% blood loss, minimal tachycardia, no measurable changes in BP, HR, RR
rhage ex. someone who donated blood
22. Class II Hemor- 15-30%, uncomplicated hemorrhage, 1-2 L of crystalloid
rhage increased HR, narrowed pulse pressure
23. Class III Hemor-
rhage
